Which patient action indicates a good understanding of the nurse’s teaching about the use of an insulin pump?

Correct Answer: A

Rationale: ### **Comprehensive Rationale for the Correct Answer** **Correct Answer: A – The patient programs the pump for an insulin bolus after eating** An insulin pump is a device that delivers continuous subcutaneous insulin infusion to mimic the pancreas's basal insulin secretion while also allowing for additional bolus doses to cover meals or correct high blood glucose levels. Programming a **bolus dose after eating** demonstrates that the patient understands the dynamic insulin needs associated with carbohydrate intake and glycemic control. 1. **Physiological Basis:** - After meals, blood glucose levels rise, requiring rapid-acting insulin to manage postprandial spikes. - A properly timed bolus (ideally given **before** eating, but programming it **after** still shows understanding of the need for mealtime insulin) helps prevent hyperglycemia. - Unlike fixed insulin injections, pumps allow flexibility in dosing based on real-time needs, making this an advanced self-management skill. 2. **Clinical Significance:** - Effective bolus dosing prevents complications like hyperglycemia (long-term risks: neuropathy, retinopathy) and hypoglycemia (acute risks: confusion, seizures). - A patient who adjusts insulin based on intake shows **active engagement** in diabetes management, a key goal of pump therapy. --- ### **Why the Other Choices Are Incorrect** **B: The patient changes the insertion site every week** - **Issue:** Insulin pump infusion sets should be changed **every 2–3 days** (not weekly) to prevent: - **Lipohypertrophy** (fat tissue buildup from repeated insulin exposure), which impairs absorption. - **Infection risk** (prolonged site use increases bacterial growth). - **Teaching Point:** Patients must learn proper rotation (e.g., abdomen, thighs, arms) and timing to ensure optimal insulin delivery. **C: The patient takes the pump off at bedtime and starts it again each morning** - **Issue:** Insulin pumps provide **continuous basal insulin**; removing it overnight leads to: - **Uncontrolled dawn phenomenon** (morning glucose rise due to hormonal changes). - **Risk of diabetic ketoacidosis (DKA)** from prolonged insulin absence. - **Exception:** Some pumps allow temporary disconnection (e.g., for swimming), but cessation for sleep is unsafe without alternative basal insulin coverage. **D: The patient plans for a diet that is less flexible when using the insulin pump** - **Issue:** A major advantage of pump therapy is **dietary flexibility** (e.g., adjustable boluses for varied carb intake). - Rigid diets negate this benefit and may reflect misunderstanding. - Pumps allow precise insulin matching to food choices, unlike fixed-dose injections. - **Teaching Point:** Patients should learn carbohydrate counting and bolus calculations for optimal control. --- ### **Conclusion** Answer **A** is correct because it reflects an understanding of **dynamic insulin dosing**, a cornerstone of pump therapy. The incorrect choices either show **misapplication of pump guidelines** (B, C) or **missed opportunities for glycemic flexibility** (D). Effective teaching ensures patients leverage the pump’s capabilities while avoiding pitfalls like infection or DKA. *(Rationale length: ~1,500 characters)*

Correct Answer: C

Rationale: The correct action for the nurse to take first when a patient reports feeling lightheaded and sweaty after being weaned off an insulin drip is to obtain a glucose reading using a finger stick. This will provide crucial information on the patient's current blood glucose level, helping the nurse assess if the symptoms are due to hypoglycemia. Based on the glucose reading, appropriate interventions can be initiated, such as administering dextrose, glucagon, or oral sugars like orange juice if hypoglycemia is confirmed. However, verifying the blood glucose level is the initial step to guide subsequent actions and ensure patient safety.

Correct Answer: B

Rationale: The patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention as it is an emergency situation that requires prompt intervention to prevent adverse effects. Severe hypoglycemia can lead to serious complications, such as seizures or loss of consciousness. Therefore, the nurse should prioritize assessing and managing this patient first to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. A high hemoglobin A1C level, an abnormal oral glucose tolerance test result, and acute abdominal pain, while important, do not pose an immediate threat to the patient's life compared to severe hypoglycemia.

Correct Answer: B

Rationale: The correct time for the nurse to initiate discharge planning for a client experiencing an exacerbation of heart failure is as soon as the client's condition is stable. Discharge planning should begin early in the admission process to ensure a smooth transition and continuity of care. While involving the client's family in the planning process is crucial, the primary focus should be on starting the preparations for discharge once the client's immediate health concerns are addressed and their condition is stable. Waiting for a team conference or after consulting with the family may delay the planning process, which is not ideal in ensuring a timely and effective discharge plan.

Correct Answer: D

Rationale: When a client is receiving pain medication through a PCA pump, it is essential to adjust the settings if their pain level is not adequately controlled. Increasing the basal rate and shortening the lock-out interval time can help manage the client's pain more effectively. This adjustment should be made by the healthcare provider based on the client's pain assessment and response to the current settings. It is crucial to individualize the PCA pump settings to optimize pain management for each client. Choices A, B, and C are incorrect because educating the family not to push the button, explaining vital sign monitoring, and setting a specific pain level for button pushing are not direct actions the nurse should take to adjust the PCA pump settings for effective pain management.